Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Acta Neurochir (Wien). 2024 Oct 5;166(1):395. doi: 10.1007/s00701-024-06279-5.
Anterior communicating artery (ACOM) aneurysms are among the most common aneurysms associated with aneurysmal subarachnoid hemorrhage (International Study of Unruptured Intracranial Aneurysms I (N Engl J Med 339:1725-1733, 1998), Wiebers (Lancet 362:103-110, 2003)). Surgical clipping of posterior-superiorly projecting ACOM aneurysms can be challenging, as the ipsilateral A2 can interfere with clip trajectory and ACOM perforating vessels obstructed from view. Intraluminal coils can further increase the difficulty of the procedure.
The relevant surgical anatomy with illustration is presented. A video detailing our technique on an illustrative case is provided.
Surgical clipping of posterior-superiorly projecting ACOM aneurysms can require complex clip configurations. We describe the key steps of posterior-superiorly projecting ACOM aneurysm clipping through a lateral supraorbital craniotomy and fenestrated tandem clipping.
前交通动脉（ACOM）动脉瘤是最常见的与蛛网膜下腔出血相关的动脉瘤之一（国际未破裂颅内动脉瘤研究 I（N Engl J Med 339：1725-1733，1998），Wiebers（Lancet 362：103-110，2003））。对于后上方突出的 ACOM 动脉瘤，手术夹闭可能具有挑战性，因为同侧 A2 可能会干扰夹闭轨迹，并且 ACOM 穿支血管被遮挡而无法观察。腔内线圈进一步增加了手术的难度。
介绍了相关的手术解剖结构，并附有插图。提供了详细介绍说明性病例的技术视频。
对于后上方突出的 ACOM 动脉瘤的手术夹闭可能需要复杂的夹合配置。我们通过外侧眶上颅骨切开术和开窗式串联夹闭来描述后上方突出的 ACOM 动脉瘤夹闭的关键步骤。
